Background Determinants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country. Aim We used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources. Methods We conducted a retrospective cohort study including 20,293 laboratory-confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions. Results Increasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70–79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0). Conclusions Older age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.
【저자키워드】 COVID-19, Risk factors, intensive care, death, Hospital admission, determinants, 【초록키워드】 severe COVID-19, COVID-19 pandemic, immunodeficiency, Lung disease, risk, risk factor, ICU, Clinical outcome, kidney, outcomes, risk stratification, Surveillance, healthcare, ICU admission, Public health interventions, age, epidemiological, Portugal, hospitalisation, Admission, early stage, association, Support, determinant, public health measure, retrospective cohort study, Older, adjusted relative risk, surveillance data, National, laboratory-confirmed, resources, country, clinical guideline, chronic neurological disease, Poisson regressions, Result, identify, reported, conducted, calculated, adjusted, Increasing, aRR, clinical factor, 【제목키워드】 Portugal, Admission, determinant, hospitalisations, COVID-19 case, reported,